Intestinal obstruction after C&D can be caused by various factors, especially if the bowel is used to create the urinary diversion. The exact cause of this obstruction has yet to be determined in various studies and potentially determining the reasons for the occurrence of this complication might help identify potential technical errors in the procedure that can be corrected.

In a recent study by I. M. Varkarakis and colleagues from Athens, Greece the intra-operative findings upon re-exploration for obstructive ileus after C&D were examined to help determine possible causes for the obstruction and aid in the development of alterations in surgical technique to avoid this complication. The study is published in the April 20067 issue of BJU Int.

Over a 12-year period, 448 C&D's with ileal conduit diversion were performed and followed by the authors. The charts of these patients were retrospectively examined for the diagnosis of early (< 30 days) or late abdominal re-exploration. The operative reports of these patients requiring a second abdominal exploration were examined for the reason of the small bowel obstruction (SBO). In addition, the type of entero-enteric anastomosis was compared between patients who required re-exploration for SBO and those that did not.

Analysis of the results showed that 14 (3.2%) and 32 (7.3%) patients required exploration for SBO in the early and late postoperative period respectively. The mean time to re-exploration was 5.8 days and 7.2 months in the early and late groups. The most common reasons for SBO were anastomotic malfunction (1.4%) and malignant recurrence (2.8%). Adhesions were the second most common cause leading to ileus in both periods (1.1% and 2.3%, respectively). When there was no retro-peritonealization of the uretero-enteric anastomosis SBO occurred more often both early and late (P =0.06). Early anastomotic malfunction leading to SBO was more common (but not statistically significant) when the entero-enteric anastomosis was hand-sutured and-to-end.

In conclusion, anastomotic malfunction, bowel adhesions and internal hernias are responsible for SBO early after surgery. These reasons, along with malignant recurrence are the most common reasons for SBO in the late postoperative period. The authors reported that the retro-peritonealization of the uretero-enteric anastomosis can reduce the risk of both early and late obstruction.

Varkarakis IM, Chrisofos M, Antoniou N, Papatsoris A and Deliveliotis C

BJU Int. 99(4):893-7. April 2007
doi:10.1111/j.1464-410X.2006.06644.x

UroToday.com Bladder Cancer Section

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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